Managing Lactose Intolerance
An apprehensive grumbling in your stomach after a meal might point towards lactose intolerance.
At birth, a majority of the population can digest lactose, which is the main carbohydrate found in mammalian milk as well as the primary source of nutrition before weaning takes place. While growing up, however, as much as 75% of the population begins to lose the capacity to digest lactose while the rest can continue to do so even as adults.
Lactose, through water and other compounds, is broken down by lactase, an enzyme present in the intestine, into digestible sugars in the form of glucose and galactose. When it comes to most infants, the intestinal lactase function is at its peak during the perinatal period. Roundabout 2–12 years of age, however, two separate groups usually form—a lactase non-persistence group that has low lactase function (hypolactasia) and a lactase-persistence group that goes on to maintain their regular lactase function.
Impaired digestion or maldigestion of lactose is the main disorder that emerges due to a reduced lactase function. Usually, this does not present any symptoms but when it does, it usually manifests as a lactose intolerance diagnosis. Primary hypolactasia and secondary causes of maldigestion of lactose including celiac disease, infectious enteritis or Crohn’s disease are distinct, and it is important to note this difference since they appear and are treated in different ways.
Essentially, lactose intolerance comes about due to smaller amounts of the enzyme lactase, which is necessary for lactose digestion. People with lactose intolerance experience digestive problems due to dairy consumption which can then create problems in their lifestyles. It is also possible for lactose intolerance to emerge at a later point, even if you are already an adult.
Symptoms
Lack of proper management and treatment can lead to severe digestive problems, with symptoms even appearing 30–60 minutes after eating.
Symptoms include:
abdominal cramps
gas
diarrhoea
constipation
nausea
vomiting
lower belly pain
bowel urgency
Undigested lactose in the small intestine can result in water moving to your digestive tract, resulting in diarrhoea.
The bacteria in your gut ferments the lactose after it makes it way to the colon, creating short chain fatty acids (SCFAs) and gas. This can lead to symptoms like bloating, gas, and pain.
How intense your symptoms are can differ depending on your lactose tolerance level as well as the quantity you have consumed.
Luckily, the symptoms that you experience are usually quite short-lived. You might also end up not feeling any impact unless you have consumed too much lactose or have another underlying condition that can get adversely affected.
Of course, the main symptoms of lactose intolerance manifest in a gastrointestinal manner. However, there are also reports of other symptoms such as headaches, fatigue, loss of concentration, eczema, mouth ulcers, muscle and joint pain and problems urinating, among others.
It is also important to note that a milk allergy and lactose intolerance are not the same thing. However, they frequently tend to occur simultaneously, making it difficult to pinpoint the exact cause.
Unlike lactose intolerance, moreover, a milk allergy can be potentially fatal, which is why getting the right diagnosis is extremely important, especially in children.
Aetiology
Lactose includes glucose and galactose as its main components.
The presence of the enzyme lactase is essential to break lactose down into glucose and galactose so that they can get absorbed into your bloodstream for energy. Lactase is found
most abundantly in the mid part of the small intestine – the jejunum , and it specifically only hydrolyses lactose. It is found at the tip of the intestinal villi so it is more sensitive to intestinal diseases that cause cell damage than other carbohydrates, which are located deeper.
In the absence of enough lactase, the lactose remains undigested, moving into your gut and resulting in digestive issues.
Types of lactose intolerance
Primary lactose intolerance
This is the most prevalent type of lactose intolerance, coming about due to an age-related reduction in lactase production. This essentially means that your capacity to absorb lactase goes on decreasing with time.
It is possible for this kind of intolerance to be genetic to a certain extent since it is more prevalent in some populations around the world as compared to others.
Based on research, primary lactose intolerance affects less than 10% of Northern European people, approximately 50% of Latin and Middle Eastern people, and as much as 80–99% of African and Asian people.
Secondary lactose intolerance
Secondary lactose intolerance can occur because of another condition affecting the small intestine, where lactase production takes place. Inflammation in your gut linings or walls can result in a temporarily reduced lactase production.
Some of these other conditions include Crohn’s disease, celiac disease, chemotherapy, ulcerative colitis, and aging.
Congenital lactose intolerance
Congenital lactose intolerance mainly occurs in newborns. This is a rare and genetic condition that the infant inherits if both parents have this particular gene mutation.
Because of this, nursing cannot take place as usual and the condition can be fatal if not diagnosed in time. Severe diarrhea and high calcium levels are some side effects of this condition. This condition is usually permanent.
Developmental lactose intolerance
Developmental lactose intolerance is also found in infants but mainly develops in premature babies since their digestive system is still not well formed, resulting in symptoms like digestive distress.
Usually, this kind of intolerance resolves and settles over time, but until then, switching from breast milk to lactose-free formula might be a better idea.
Risk factors
Some risk factors can affect certain people more than others. These include the following:
• Asian or African heritage
• a medical history of digestive disorders
• lactose intolerance in the family
A study conducted by Dr. Tandon and Dr. Joshi in India to figure out the occurrence of lactose intolerance in healthy participants from all over the country found that there was a lesser occurrence in participants from North India than those from South India. This can perhaps be attributed to their ancestry in which dairying was a common phenomenon ( 10.1093/ajcn/34.5.943 )
Tests for Lactose Intolerance
Some tests that can help diagnose lactose intolerance include:
Hydrogen breath test
Lactose tolerance test
Genetic test
Stool acidity test
Biopsy of the jejunal brush border for lactase activity
Elimination and reintroduction test
Can nutrition be managed without consuming dairy?
Dairy products generally contain plenty of nutrients that can have several benefits on your health such as high bone mineral density, which can then reduce the risk of bone fractures.
Lactose intolerance, however, might force you to reduce or stop your dairy intake and consumption.
Dairy products have plenty of calcium that is essential for your body, although you can still maintain a good calcium level in your body without consuming any kind of dairy. Some other calcium-rich foods include:
Calcium-fortified foods (not as common in India)
Boned fish (but what about vegetarians?)
High calcium plant foods like kale, broccoli, spinach, beans, peas, lentils, soybean (in the form of tofu, tempeh and natto), nuts such as almonds, seeds like sesame, Chia and flax, and grains like ragi and amaranth
Unfortunately, calcium from plant foods might not get absorbed properly because of anti-nutrients like phytate, oxalate and lectins.
All common dairy products will contain lactose to some extent or the other. You should also confirm the lactose level if you frequently consume manufactured food products.
Checking food labels can let you know whether that food contains dairy. Usually, you can identify dairy on the labels as milk solids, whey, curds, milk powder, malted milk, milk sugars or dry milk solids.
Some products might have a higher lactose level as compared to others. For instance, different types of cheese have different lactose levels. Soft cheeses like brie tend to be high in lactose, while hard cheeses like parmesan contain only small quantities.
Lactose-free alternatives
Getting rid of the lactose in some dairy products by breaking it down into glucose and galactose during the manufacturing process itself can be a viable solution. Plant-based dairy products —almond milk, coconut milk and yogurt, oats milk, peanut milk, soy ice cream, and cashew cheese — are also naturally free of lactose.
Treatment options for lactose intolerance
You can still consume dairy if you consider trying out the following kinds of treatment.
Enzyme supplements
Taking enzyme supplements can make it easier for your body to digest lactose.
How useful and effective these supplements are, however, can differ depending on the product you use. They might either have no noticeable impact or might reduce your lactose intolerance levels by a small amount, giving favorable hydrogen breath test results.
Yet another impact can be a reduction in symptoms without any impact on the hydrogen breath test results, suggesting a placebo effect.
Before you take supplements of any kind, you must consult a doctor.
Lactose exposure
Lactose exposure means that you can continue your lactose intake and gradually increase the quantity so that your body can get used to it.
Research to support this method is limited, but the initial few results are quite favourable.
Through this method, your gut microbiota can build the capacity to produce sufficient lactase on its own so that your symptoms can reduce bit by bit.
You should carry out this method consistently to ensure its effectiveness. It might also be better to use high fat milk (like whole milk) since it takes longer for your body to digest, providing more time to your gut bacteria to carry out the digestion process.
Probiotics and prebiotics
Probiotics are microorganisms whereas prebiotics are fibers that probiotics can feed on, thereby feeding the useful bacteria in your gut.
Both probiotics and prebiotics can ease the symptoms of lactose intolerance, although not enough research has been conducted in this area.
Certain kinds of probiotics and prebiotics can have a better impact than others. For instance, Bifidobacteria and Lactobacillus strains, found in probiotic yogurts and supplements, are quite beneficial.
Can you still eat dairy with lactose intolerance?
If you have lactose intolerance, you can probably still consume lactose in limited quantities, with your body being able to digest some dairy products like butter, yogurt, and hard cheeses better than milk.
Lactose is present in all dairy products, but this doesn’t imply that you cannot consume them at all.
For instance, some people can tolerate milk in tea but might not be able to tolerate a bowl of kheer.
It is believed that people with lactose intolerance can tolerate approximately 18 grams of lactose in a day. Some studies also suggest that people might be able to tolerate up to 12 grams in a single sitting, which amounts to around a cup (240 mL) of milk.
Further, some dairy products naturally have low lactose levels even if you eat them in their typical portions. Butter, for example, comprises trace amounts of lactose. Similarly, some cheeses like Parmesan, cheddar, and Swiss have less than 1 gram of lactose per 1-ounce (28-gram) serving. Hard cheeses, in general, have lower lactose levels than soft cheeses.
Curds, moreover, usually result in fewer or less intense symptoms as compared to other dairy products, possibly because the probiotics in curds have lactase that can make the digestion of lactose easier.
Summing Up
Lactose intolerance is of different kinds and comes with its own range of symptoms. Recognising these symptoms early on can help prevent major issues later, although intolerance
itself is quite manageable. Different dairy products also contain different levels of lactose, making it possible to consume a few of them in moderation.
You can also entirely opt out of dairy consumption or try out a few other treatments depending on your requirements as well as what your doctor suggests.